~ 544 ~ International Journal of Orthopaedics Sciences 2018; 4(1): 544-547 ISSN: 2395-1958 IJOS 2018; 4(1): 544-547 © 2018 IJOS www.orthopaper.com Received: 16-11-2017 Accepted: 18-12-2017 Dr. Shah Waliullah Asst Professor, Dept. of Orthopaedic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India Dr. Vineet Kumar Asst Professor, Dept. of Orthopaedic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India Dr. Dharmendra Asst Professor, Dept. of Orthopaedic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India Dr. Deepak Asst Professor, Dept. of Orthopaedic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India Dr. Devarshi Rastogi Asst Professor, Dept. of Orthopaedic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India Dr. RN Srivastava Professor, Dept. of Orthopaedic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India Correspondence Dr. Shah Waliullah Asst Professor, Dept. of Orthopaedic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India Reverse distal femoral locking plate for the management of unstable peritrochanteric femoral fracture Dr. Shah Waliullah, Dr. Vineet Kumar, Dr. Dharmendra, Dr. Deepak, Dr. Devarshi Rastogi and Dr. RN Srivastava DOI: https://doi.org/10.22271/ortho.2018.v4.i1h.80 Abstract Background: Dynamic Hip screw(DHS) is gold standard for fixation of stable intertrochanteric fractures and for unstable fractures proximal femoral nail (PFN) is preferred implant however PFN is technically demanding and has frequent complications. We have evaluated the efficacy of reverse supracondylar locking plate for the management of unstable peritrochanteric fractures. Methods and material: 23 patients with unstable peritrochanteric fracture were recruited in our study as per AO classification. All the patients, after getting informed consent, were treated surgically by reverse supracondylar locking plate. Functional outcome was evaluated in terms of Harris Hip Score. Results: After a minimum follow-up of 29 months, all patients have shown fracture healing and union at mean of 12.4 weeks. The Harris Hip score at most recent follow up was 84.1. Outcomes were excellent in 14.2%, good in 61.9%, fair in 9.5%while poor in 14.2%. Conclusion: By virtue of our results we can recommend that reverse supracondylar locking plate can be used as an alternative, viable and easily available implant that can be used effectively for unstable peritrochanteric fractures. Keywords: Reverse distal femoral locking plate, unstable peritrochanteric femoral fracture Introduction Trochanteric fracture is a major cause of morbidity and mortality in elderly patients. To avoid this morbidity and mortality, these fractures should be treated at earliest; optimum treatment requires adequate reduction, stable internal fixation and early mobilization. Stable internal fixation can be achieved with either intramedullary or extramedullary implants, however there is lack of consensus regarding fixation of unstable peritrochanteric fractures, whether they do better with intramedullary or extramedullary implants [1, 2, 3] . Proximal femoral nail, by virtue of its biomechanical properties, provides rotational stability to proximal fragment, however PFN is technically demanding and frequently associated with implant failure and failed osteosynthesis [4, 5, 6] . Distal femoral locking plate anatomy matches with opposite proximal femur [7, 8] and so it can be used as an alternative extramedullary implant. We have evaluated the efficacy of reverse supracondylar locking plate for the management of unstable peritrochanteric fractures. Methods and material 23 patients with unstable peritrochanteric fracture, admitted in our department from March 2010 to July 2012, were recruited in our study. Patients were classified as per AO Classification [9] , 13 patients belong to 31 A3 type while rest 10 patients were having 32 C3.1 type fracture. There were 15 males and 8 female patients with mean age 71.9years (range from 46years-94years). All of the patients, after getting informed consent, were treated surgically either by direct or indirect reduction and internal fixation by reverse supracondylar locking plate. All patients were operated under regional or general anaesthesia, in supine position on fracture table under image intensifier control.